5 Things You Need to Know About CMS’s First-Ever Mandatory Bundled Payment Program

Patient engagement technology can help hospitals meet the cost containment requirement for Comprehensive Care for Joint Replacement starting in four months.

[December 4, 2015, Mountain View, CA] — A new landmark program from the Centers for Medicare and Medicaid Services (CMS) is slated to go into effect with US hospitals just four months from now on April 1, 2016. Comprehensive Care for Joint Replacement (CJR) is the first mandatory test of a shared-risk, outcomes-based payment model, and is the first initiative to make hospitals financially responsible for patient recovery 90 days after a knee or hip replacement surgery.

 

Here are five things hospitals and health leaders need to know about this step forward for coordinated care:

 

  1. 789 hospitals will be impacted – Hospitals in 67 geographic areas across the country have been selected for the first pilot of the mandatory CJR bundled payment program in 2016. The list includes major metro regions such as New York, Los Angeles, and Pittsburgh as well as smaller areas around Modesto (CA), Dothan (AL), and Tyler (TX). See HealthLoop’s interactive map of the 67 CJR regions.

 

  1. Half a million patients could participate annually – Knee and hip replacements are the No. 1 most common inpatient surgery for Medicare fee-for-service patients. There are over 400,000 Medicare hip and knee replacement surgeries in the US each year, costing $7 billion for hospitalizations alone. See more data on Medicare joint replacement surgeries and outcomes.

 

  1. Quality matters – Not only do hospitals have to keep the cost of care down from admission to 90 days post discharge, they also have to adhere to strict quality metrics including reduction of complications from surgery and patient satisfaction measured by HCAHPS. Underperforming hospitals will face even bigger cost penalties and may not be able to participate in gaining a share of the savings. Hospitals can find out how they score with HealthLoop’s CJR Are You On the Map? online tool.

 

  1. Hospitals can donate up to $1000 per Medicare beneficiary in patient engagement technology and services – CJR lifts longstanding anti-kickback rules, allowing hospitals to give physicians up to $1000 in technology and services for patient engagement solutions to be provided during the 90 day recovery period – a potential $400 million opportunity for patient engagement companies. Medicare will also begin reimbursing for telemedicine and waiving minimum hospital stay rules.

 

  1. CMS is providing incentives for Patient Reported Outcomes (PRO) – Voluntarily sharing total joint replacement patient-reported outcomes measures is an easy way for hospitals to improve their composite quality scores and be able to participate in gain sharing with physicians. In the first year, hospitals will need to report 50% of their total joint replacement patients’ PRO data or at least 50 patients to earn two additional bonus points on their composite quality score.

 

Join Dr. James Caillouette, a noted orthopedic surgeon and expert on bundled payments and hospital collaboration, and Dr. Kavita Patel, a Nonresident Senior Fellow at the Brookings Institution and a former Director of Policy for the White House under President Obama for a webinar on CJR on December 11th at 10 am PST. Click here to register.

 

“After decades of concern over rising healthcare costs, CMS is taking bold action in 2016 with the mandatory CJR program,” said Todd Johnson, CEO of HealthLoop, the largest patient engagement platform in the orthopedic space. “Now, it’s up to hospitals and health technology vendors to work together to make the Medicare joint replacement program an example of successful care coordination that can lead to lower costs and increased healthcare quality.”

 

Since 2009, when President Obama addressed a joint session of Congress, there has been an increased focus on cost reduction and increased quality of care in the US healthcare system. “[We] can help encourage the adoption of these common-sense best practices by doctors and medical professionals throughout the system — everything from reducing hospital infection rates to encouraging better coordination between teams of doctors,” said President Obama.

 

“As a physician, it is hopeful to see policy changes coming into reality that improve patient recovery and the way we practice medicine,” said Dr. Patel. “CJR will support surgeons in focusing on the long-term outcome of patient care, not just the delivery of surgery. This is a big step forward for increasing value and cutting costs equally.”

 

This CJR information is provided by HealthLoop, the national leader in pre- and post-surgery patient engagement. HealthLoop has helped improve outcomes for over 20,000 orthopedic surgery patients over the last three years with partners including Cedars-Sinai Medical Center. The company is offering a webinar on five key CJR topics in December as well as a bundled payment toolkit available to hospitals online anytime. Journalists interested in details about the impact of CJR on their readers are invited to email media@healthloop.com for custom local research.

 

About HealthLoop

 

HealthLoop is re-imagining patient experience by guiding care team communications. The company provides peer-reviewed, automated patient support that is insightful and engaging to increase adherence and comprehension. HealthLoop enables value-based care for hospitals to monitor at-risk populations, provide outreach when most needed and track patients through an episode of care. Patients rate their doctors with a 5-star experience and providers realize better efficiencies with an automated patient check-in approach. Located in Mountain View, HealthLoop facilitates over 25,000 automated check-ins each month.

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